Dr. MJ Bazos MD,
Control for Women
Why Talk About Bladder Control?
Women of all ages have bladder control
problems. Some younger women find they can't hold their urine after having a
baby. Others have problems when they stop having periods. Many women over the
age of 75 also have bladder control problems. You may feel ashamed about bladder
control problems. Remember that it's a medical problem and it's not your fault.
Millions of women have the same problem. Don't believe people who tell you that
urine leakage is normal. It isn't. Most of the time it can be improved. Your
health care team can help you. Nearly everyone with a bladder control problem
can be helped. Call your clinic and find out how.
Where Can You Go For Help?
You can do many things to help improve
your bladder control. Talk to your family doctor or nurse.
If you have a more difficult case, you may
need to see a urologist (yoor-ALL-uh-jist). Urologists are experts in bladder
and urine problems.
(guy-nuh-CALL-uh-jist) is a doctor who treats problems of the female system.
Your gynecologist can also help you with bladder control. Your doctor might also
want you to see a urogynecologist (YOOR-oh-guy-nuh-CALL-uh-jist).
Urogynecologists treat women's bladder and urine problems.
You can also get help from a urology or
continence nurse. Visiting home nurses can help you learn about bladder control.
Some physical therapists help people with pelvic muscle exercise programs.
Check with your insurance plan about
payment for these services. You may need a referral from your regular doctor.
If you feel shy about calling a doctor or
nurse, maybe a support group can help you. Some groups will talk to you on their
toll free number. Others have free or inexpensive brochures and videos about
bladder control. Support groups and patient organizations are listed at the end
of this brochure.
What Does the
Doctor Need to Know?
You will need to
keep a record. Try to write down the times when you go to the bathroom. Write
down when you have accidents, too. Do this for a day or more. This record is
called a bladder control diary. Diaries help your doctor or nurse learn the
cause of your problem.
Doctor Needs to Know
I take these prescription medicines:
I take these over-the-counter drugs (such as
Tylenol, aspirin, or Maalox):
If you take more medicines, please list them on
a separate paper.
I started having bladder trouble
_______1 to 2 years ago
Number of babies I have
My periods stopped (menopause).
I recently had an operation.
I recently hurt myself or have been sick.
Type of injury or
I recently had a bladder (urinary tract)
- I am often constipated.
- I have pain or burning feelings when going to the
- I often have a really strong urge to go to the
toilet right away.
- Sometimes my bladder feels full, even after I go
to the toilet.
- I go to the toilet often, but very little urine
- I don't go out with friends or family because I
worry about leaking urine.
- The first thing I do at new places is check the
- I worry about being put in a nursing home because
of bladder control problems.
I have (or had) these
- _______Crippling arthritis
- _______Interstitial cystitis
- _______Multiple sclerosis
- _______Spinal cord injury
- _______Urinary infection
- _______I smoke cigarettes
Will the Doctor Do
You will probably have a
physical exam. The exam can show the reasons for your bladder control problem.
First, your health care team will look for a simple cause. It could be an
infection in the bladder or urethra. This can be treated easily.
The reason for your problem may be harder
to find. Then, the doctor or nurse may want to do some tests:
- Check to see how well the bladder muscles are
doing their jobs.
- Take samples of urine and blood for tests.
- Look for something blocking the urine
flow—like a stone, a growth, or hard bowel movement or stool.
- Take pictures of your bladder, using special
What does the
bladder control system look like?
of your bladder control system lies inside your pelvis. Stand with your hands on
your hips. The bones under your hands are the pelvic bones. Your pelvis is
shaped like a big bowl. The bottom of this "bowl" is the area between your legs.
The muscles across this area are the pelvic floor muscles.
Your bladder is another muscle. It is a
balloon-shaped organ inside your pelvis, just below your belly button. Your
pelvic floor muscles should be strong and tight to hold up your bladder in its
proper place. Your bladder should stay relaxed when it is full of urine. But,
when you go to the bathroom, the bladder muscle should tighten. This squeezes
urine out of the bladder.
sphincter (SFINK-tur) muscles are two muscles that surround the tube that
carries urine from your bladder down to an opening in front of the vagina. The
tube is called the urethra (yoo-REE-thrah). Urine leaves your body through this
tube. The sphincters keep the urethra closed by squeezing like tight rubber
bands. The pelvic floor muscles also help keep the urethra closed. Urine stays
inside your body when the pelvic floor and sphincter muscles are tight and the
bladder is relaxed.
When the bladder
is full, nerves in your bladder signal the brain. That's when you get the urge
to go to the bathroom. Once you reach the toilet, your brain sends a message
down to the sphincter and pelvic floor muscles. It tells them to relax. The
brain signal also tells the bladder muscles to tighten up. That squeezes urine
out of the bladder.
means you urinate only when you want to. For good bladder control, all parts of
your system must work together.
- Pelvic muscles must hold up the bladder and
- Sphincter muscles must open and shut the urethra.
- Nerves must control the muscles of the bladder
and pelvic floor.
Causes Bladder Control Problems?
bladder control problems happen when muscles are weak or too active. Problems
may also happen when nerve signals don't work properly.
If the muscles that keep your bladder
closed are weak, you may have accidents when you sneeze, laugh, or lift a heavy
object. This is called stress incontinence. It is the most common type of
bladder control problem. Stress incontinence often occurs when women are
pregnant or after childbirth. The pelvic floor muscles stretch and weaken in
pregnancy or childbirth. The same muscles become weak after a woman stops having
periods (menopause). They weaken because they no longer get female hormones.
Sometimes, the bladder muscles become
too active. Then you have a different problem. You may feel strong, sudden urges
to go to the bathroom, even if your bladder has little urine. This kind of
bladder problem is called urge incontinence.
Several things can cause your bladder
to be too active:
- a bladder infection
- nerve damage (sometimes from childbirth)
- drinking alcohol (beer, wine, etc.)
- some medicines
What Is the Treatment
for Bladder Control Problems?
treatment will depend on the type of bladder control problem you have. Some
treatments are simple. Others are more complicated. Your health care team may
suggest one of the following treatments:
Pelvic Muscle Exercises.
You can learn simple exercises that can strengthen the muscles near
the urethra. These are called pelvic muscle exercises or Kegel
exercises and take only a few minutes a day.
Bladder Training. You
can train your bladder to hold urine better. Follow a timetable to store and
release urine. You can also learn to decrease the urge to urinate.
Sometimes extra weight causes bladder control problems. A good meal
plan and exercise program can lead to weight loss.
Food and Drink. Some
drinks and foods may make urine control harder. These include foods with
caffeine (coffee, tea, cola, or chocolate) and alcohol. Your health care team
can suggest how to change your diet for better bladder control.
Stimulation. Certain devices stimulate the muscles around the
urethra. This makes the muscles stronger and tighter.
takes the guesswork out of pelvic muscle exercise. A therapist places a patch
over the muscles. A wire connects the patch to a TV screen. You watch the screen
to see if you are exercising the right muscles. The therapist will help you.
Soon you learn to control these muscles without the patch or screen.
Certain drugs can tighten or strengthen urethral and pelvic floor muscles. Other
medicines can calm overactive bladder muscles.
bladder control problems can be solved by surgery. Many different operations can
improve bladder control. The operation depends on what is causing the problem.
In most cases, the surgeon changes the position of the bladder and urethra.
After the operation, the bladder control muscles work better.
Soon, you will be able to buy new
products. These products help control leaks. They do not cure the causes of
bladder control problems.
doctor can place a special device called a pessary (PESS-uh-ree) in the vagina.
The device will hold up the bladder to prevent leakage.
Urethral Inserts. Your doctor may give you
a small device that goes directly in the urethra. You can learn to insert the
device yourself. It's like a little plug. You remove the device when it is time
to go to the bathroom and then replace it until it's time to go again.
Urine Seals. This is
a small foam pad you place over the urethra opening. There it seals itself
against your body to keep urine from leaking. When you go to the bathroom, you
remove the pad and throw it away.
Pads or Diapers.
Pads or diapers help many people. But diapers do not cure bladder control
problems. See a doctor or nurse, even if diapers are working for you.
Bedside Urinal. Some
people use a bed pan or a bedside chair urinal (YOOR-uh-nul) or commode.
Assistance. If you
are disabled, health care workers can help you move more easily to a toilet.
Your doctor or nurse may teach you to urinate on a schedule that prevents
Sometimes, you just need a carpenter to make changes to your house. Perhaps you
need a hallway light. Or a downstairs bathroom. Another solution could be
widening a bathroom door to fit a wheelchair.
Points to Remember
- Many women have bladder control problems.
- Bladder control problems do not have to be a
normal part of aging. Many medical conditions can cause bladder problems.
- Try not to let embarrassment about bladder
control problems keep you from talking to your health care team.
- Most cases of poor bladder control can be
- Ask your health care team for help.